Friday, October 3, 2014

Walk Out of the Darkness

Petra Kottsieper, Ph.D.

On October 5 the annual Walk Out of the Darkness, held by the American Foundation for Suicide Prevention will take place here in Philadelphia as well as many other cities around the country.
I will be walking in this walk as a person who came very close to losing a family member to suicide, know people who have successfully committed suicide, as someone who has a past history of mental health concerns,  and as a mental health professional.

"Suicide claimed 39,518 lives in 2011 in the United States alone, with someone dying by suicide every 13.3 minutes. A suicide attempt is made every minute of every day, resulting in nearly one million attempts made annually."

Losing someone to suicide is a profound event, sometimes not surprising to the families and friends of the person who choose to end his or her life, and sometimes it explodes into people’s lives completely unexpectedly. Many people who attempt or complete suicide experience extreme psychological pain and suffering and often see suicide as the only way out.  Often, people are unable to reach out in their darkest moments despite the relatively abundant resources that exist in the US. Why is this?

Stigma, fear, and hopelessness are all answers to this question. Stigma of mental illnesses remains a significant barrier to help seeking. Public stigma is not just grounded in the well documented beliefs and resulting stereotypes that people who are "crazy" are dangerous and unpredictable, but also in the fact that having "mental" problems is seen as something fundamentally different than having a "physical" problem. And while mental and physical illnesses may very well experientially vary, problems with mental health concerns are observed not only as different, but are also judged as worse. This is undoubtedly rooted in our perception of the superiority of the mind over our body; mind as the seat of our "rationality" and emotional balance.  In addition, some "mental health” problems, obviously due to their complexity, remain poorly understood.  In other cases we know a lot, have effective treatments, but these treatments are still not considered readily acceptable to be sought out.  Acknowledging that a family member, friend, or even oneself is having a mental health concern means that one has to accept this in the context of likely societal distancing and associated negative judgments.       

This is where the annual walk comes in.  The walk addresses what is at the heart of the pervasive problem of stigma that continues to exist and makes it hard for many people to seek help for the problems they are experiencing. The walk is about "coming out," shining a light on the significant public health issues of suicide and having survivors come together being visible and open about having lost a family member without fear and embarrassment. Ending the taboo.

So what can we do as friends, family members, professionals, individuals who are struggling?
As a society we need to become so much more aware of what mental health problems really are. In addition to understanding their etiologies we also need to understand suicidal ideation as a phenomenological experience. This is especially important for professionals who need to work on gaining a better understanding of suicidal thoughts of his or her presenting patient.  We need to talk to people about suicide, and research indicates that even as professionals we are often not comfortable with this topic.[i]  We need to carefully examine our responses as professionals to suicidal talk of our patients and to carefully assess if hospitalization is necessary or not. In many cases it is not, but fears of liability and risk pervade our profession.
We need to continue to de-stigmatize mental health concerns and embrace the recovery framework that has become mental health policy in many parts of the US following the U.S. President's 2003 New Freedom Commission on Mental Health that emphasized the need for a transformation of our nation's mental health system.

We need to embrace the position that people generally can get better, provide hope and afford quality mental health care to everyone.  Recovery also does not always mean a return to baseline functioning. This means we all need to become more tolerant of mental health symptoms, as long as the individual chooses to live with these symptoms and the person is not endangering him/herself or others.  It means we need to treat everyone with respect, empathy, and compassion.  We need to make it acceptable for someone with an acute exacerbation of, for example, debilitating anxiety to take a sick day at work for self-care or an emergency appointment with their treatment professional, and not having to lie and call in with a cold.

If we lose someone to suicide we need to stop "forcing” survivors to talk about their grief behind 
closed doors. Research has shown that survivors of suicide are treated differently than survivors of other deaths by other causes.  Specifically, the "societal perception that the act of suicide is a failure by the victim and the family to deal with some emotional issue and ultimately society affixes blame for the loss on the survivors"  is something that we can all work on to combat in our own lives.[ii]

While I am not saying or arguing that everyone who attempts suicide has a mental illness or mental health concern, it is undoubtedly true that many people that attempt or successfully completely suicide, do.  It is time that we talk more openly and urgently about this public health crisis.  We need to end the stigma that prevents so many people from at least attempting to seek help, especially in light of the many available treatments and avenues for help that are available.  This help can be gotten from a lot of sources; families, friends, clergy, suicide hotlines, therapists, and medical professionals.  We all play a role in this.  If you know someone who is not doing well, or you suspect may not be doing well, ask them how they are really doing today.

**If you are someone you know is struggling with thoughts of suicide get help now. Contact


**If you have lost someone to suicide, there is support. Contact


[i] Walen, S.  (2002).  It’s a funny thing about suicide: a personal experience.  British Journal of Guidance & Counseling, 30, 4, 415-430.
[ii] Cvinar, G. J. (2005). Do Suicide Survivors Suffer Social Stigma: A Review of the Literature. Perspectives in Psychiatric Care, 41, 1, 14-21.